HomeMy WebLinkAboutApplicationGørfield CownQr
C.ommmity f læeÍopmert Department
1O8EúStreeÈ Suite ¡O1
Ghnn¡ood Springs, CO tl60l
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Appllcant acknowledßes that the ærnpleteness of the appltcatlon þ cqndl{gnal upon such further
rññdaiót á.d addÉnal rest and reöorts as rray be núir¡ryd ¡y tt¡e local tæaldi @artmem to be
medeand'frrn'tsffi bvttreaoof¡ca¡tôr bvthe bàl healü departmertfurptJrpocedof ütewah¡atirn
ôittreãóól¡cation;andthe ¡siuance of thé permit is_subiect to such-terms ahd i¡onditions as deemed
neæG'rt to ¡nsure ompliance with rules ånd regdations made, infonnation and-reports srlxnitH
Èãw;ttl'an¿ rcrn¡fed to be rubmilted by Ure app¡ca* are or udl be rcpesented U bç Ù.F ðd
corrca to the beit of my knowledge and irel¡ef ãnd are designed to be relied on by lhe lgca!
dãoartment of health in'evaluatinãthe same for purposes of issuingthe permit applh_d forherein. I
further u¡rderstand that anv fakiñcaion or m¡gepresentat¡on nrry result in the den¡al of üE
appi¡cation or ret ocãtbn oi arry permit gnnted b-ased upon said Cpplication and legpl acti'on frr periury
as prodded by law.
I lçreüy admowledte that I lrare rcad a¡rd understald ttre f{oüce and Ccrtiñcatht aborc as rell as
lnucputldedthc ffinrdon rlúdr b ørçt r¡d ærðÞ b úc be¡t of my hnqrlc*e-
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